Singapore General Hospital Nursing Care Procedures

TITLE Administering Total Parenteral Nutrition (TPN) ISSUED B INITI!L D!TE ISSUED D!TE "E#ISED "E#ISION NUMBE" : Nursing Division : 1 De! 1"#" : $1 %ar $011 : 0& DOCUMENT NO: 60100-NCP-C1007 !PP"O#ED B : Dire!tor' Nursing Page 1 of 4

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PU"POSE To infuse )arenteral nutrition to meet t*e )atient+s total nutritional re,uirement(

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"E'UISITES Trolle- .it* t*e follo.ing items: dressing set intravenous infusion set (non-filter) inline infusion filter (1($ mi!rons' )rovided /- )*arma!-) sterile gloves TPN solution /ag ()rovided /- )*arma!-) !leansing lotions 0 C*lor*e1idine 2lu!onate $3 .it* Al!o*ol 703 or e,uivalent !leansing lotions dis)osa/le go.n ad*esive ta)e re!e)ta!les for used instruments and items infusion stand .it* infusion )um) (/- )atient+s /edside)(

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P"OCEDU"E !CTION "!TION!LE To )revent venous s)asm and *-)ot*ermia as a result of infusing !old intravenous solution( To alla- an1iet- and o/tain )atient+s !oo)eration(

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4eave TPN /ag in room tem)erature for at least one *our /efore infusion(

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51)lain )ro!edure and )ur)ose to )atient( C)ec* t)e +ollo,ing: !*e!6 )atient+s name as stated on TPN /ag and order form .it* )atient and against )atient+s identifi!ation /and(

To ensure t*at TPN is given to t*e !orre!t )atient

Singapore General Hospital Nursing Care Procedures

TITLE Administering Total Parenteral Nutrition (TPN) ISSUED B INITI!L D!TE ISSUED D!TE "E#ISED "E#ISION NUMBE" : Nursing Division : 1 De! 1"#" : $1 %ar $011 : 0& DOCUMENT NO: 60100-NCP-C1007 !PP"O#ED B : Dire!tor' Nursing Page $ of 4

!CTION !*e!6 for !orre!t TPN !om)onents as stated on t*e TPN /ag and TPN order form( !*e!6 !ontents of TPN /ag for )resen!e of dis!oloration' sediments or /rea6ing of fat emulsion' and for e1)ir- date( !orre!t route of TPN infusion(

"!TION!LE To ensure t*e !ontents are as )res!ri/ed( 7ndi!ate in!om)ati/ilit- or degradation of TPN solution(

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To )revent errors(

8ang TPN /ag .it* /la!6 /ag !over on infusion stand( Perform *and *-giene( Pre)are re,uired te!*ni,ue( re,uisites' using a non-tou!* To minimise !ross !ontamination( To minimise !ontamination( To e1)ose t*e s)i6ing )ort(

9emove )lasti! seal from t*e s)i6ing )ort of t*e TPN /ag( 4oosen t*e old dressing at t*e !onne!tion site( Clam) t*e !at*eter lumen and t*e infusion set(

To )revent air em/olism and s)illage of fluid .*en !at*eter is dis!onne!ted during !*anging of infusion set( To minimise !ross !ontamination( To )revent air em/olism(

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Perform *and *-giene( Don sterile gloves( Pri-e t)e ad-inistration set: !lam) infusion set( Pre)are & s)irit s.a/ and 1 s)irit gau:e !lean s)i6ing )ort .it* C*lor*e1idine 2lu!onate .it* Al!o*ol 703 *old s)i6ing )ort .it* a )ie!e of sterile gau:e and s)i6e t*e /ag atta!* intravenous administration set infusion filter to t*e

fill infusion set !*am/er to mid)oint and run TPN fluid t*roug* t*e tu/ing and filter to remove all t*e air in t*e tu/ing and t*e filter *ousing(

Singapore General Hospital Nursing Care Procedures

TITLE Administering Total Parenteral Nutrition (TPN) ISSUED B INITI!L D!TE ISSUED D!TE "E#ISED "E#ISION NUMBE" : Nursing Division : 1 De! 1"#" : $1 %ar $011 : 0& DOCUMENT NO: 60100-NCP-C1007 !PP"O#ED B : Dire!tor' Nursing Page of 4

!CTION Note: %aintain stri!t ase)ti! te!*ni,ue during )riming( (1$ Clean t*e !onne!tion site .it* C*lor*e1idine 2lu!onate .it* Al!o*ol 703 and )la!e a sterile dra)e under t*e !onne!tion site( Transfer t*e ne.l- )rimed administration set onto t*e dressing to.el( Clean t*e !onne!tion site again .it* C*lor*e1idine 2lu!onate and Al!o*ol 703 using gau:e /efore dis!onne!ting t*e ;old; infusion set( Clean t*e !at*eter *u/ .it* s)irit s.a/( Conne!t t*e ne.l- )rimed infusion set immediatel- to t*e !at*eter *u/( Clean s)i6ing )ort and !at*eter *u/ !onne!tion .it* C*lor*e1idine 2lu!onate .it* Al!o*ol 703 after !onne!tion s)i6ing( Cover it .it* one dr- gau:e and ta)e( Pla!e 7< tu/ing into t*e infusion )um)( =et infusion rate on t*e )um) a!!ording to t*e order )res!ri/ed( >n!lam) !at*eter and infusion set( =tart infusion( Assist )atient to a !omforta/le )osition( Perform *and *-giene and !lear used re,uisites( Perform *and *-giene( Dis)la!e an- tra))ed air /u//les /- lig*tlta))ing t*e filter *ousing !lam) t*e tu/ing and leave it on t*e sterile field(

"!TION!LE

To !reate a sterile field(

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To redu!e e1)osure time and to ensure t*at no air gets into t*e infusion s-stem( To redu!e ris6 of !ontamination and to remove an- s)illage .*i!* ma- *ave o!!urred during s)i6ing of TPN /ag( To maintain a stead- flo. rate to )revent ele!trol-te im/alan!e(

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To minimise !ross !ontamination(

Singapore General Hospital Nursing Care Procedures

TITLE Administering Total Parenteral Nutrition (TPN) ISSUED B INITI!L D!TE ISSUED D!TE "E#ISED "E#ISION NUMBE" : Nursing Division : 1 De! 1"#" : $1 %ar $011 : 0& DOCUMENT NO: 60100-NCP-C1007 !PP"O#ED B : Dire!tor' Nursing Page 4 of 4

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/OLLO0 UP =igns on t*e TPN order form under t*e +Nurse+s =ignature+ !olumn( 9e!ord t*e follo.ing in t*e 7nta6e and ?ut)ut @lo.s*eet: time of TPN !ommen!ement amount of TPN )atient+s inta6e and out)ut( C*e!6 )atientAs .eig*t and *eig*t on da- of TPN !ommen!ement and .eig* )atient t.o times )er .ee6 t*ereafter( C*e!6 )atient+s tem)erature' )ulse and res)iration 4 *ourl-( %onitor )atient+s /lood /io!*emistr-' renal )anel' liver )anel' !al!ium' magnesium' )*os)*ate' trigl-!erides' !*olesterol' urine s)ot sodium and sugar level as ordered /- t*e TPN team or t*e do!tor( Blood for <itamin A' B' D' 5 ' 7ron' T7BC' @erritin' C-9ea!tive Protein (C9P)' @olate and Transferrin for )atients on long term or 8ome TPN /- t*e Nutrition =u))ort =ervi!e (N==) NC or APN( IMPO"T!NT CONSIDE"!TIONS =tore TPN /ag in t*e refrigerator at 4oC( Do not infuse TPN toget*er .it* ot*er intravenous fluid via t*e same intravenous !at*eter lumen( 7ntravenous fluid ma- /e infused t*roug* se)arate lumen of a multilumen !at*eter !on!urrent .it* TPN infusion( Do not use TPN lumen for !entral venous )ressure monitoring( Do not inCe!t an- addi!tives into TPN /ag at .ard level( An- additives to TPN must /e !arried out at t*e TPN !om)ounding unit or TPN 4a/orator-( Do not use -.a- ada)tors on TPN line( TPN must /e infused at a !onstant infusion rate( Do not interru)t or dis!ontinue TPN a/ru)tl-( Consult t*e TPN team on termination of TPN( TPN re,uires )rote!tion from lig*t( T*e P*arma!ist .ill su))l- a /la!6 !overing /ag( 7ntravenous infusion set s*ould /e !*anged dail- or .it* ever- TPN /ag !*ange( >se luer lo!6 !onne!tions to )revent a!!idental dis!onne!tion of infusion s-stem( >se 1($ mi!ron inline filter .*en administering TPN( T*is filter .ill /e su))lied /- t*e TPN P*arma!ist and s*ould /e !*anged dail- or .it* ever- ne. TPN /ag(

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